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PUBLIC HLALTA ul-v-Ln,J.vrl <br /> SITE NAME ADDRESS CITY <br /> OWNER NAME��- JOWNER PHONE , <br /> CONTRACTOR 'S ���^ CONT. PHONE <br /> FIRE PERMIT , <br /> REMOVAL__�C CLOSURE IN PLACE TEMPORARY CLOSURE <br /> INSPECTOR DATE a TANK # 39 <br /> R RINSED ION) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE /Y11�FtiGctry UCt <br /> S <br /> E MANIFEST OR OTHER <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED 4�d <br /> A <br /> P READING AT REMOVAL L.E.L. : S �pP.,.i O2: 2. v <br /> O <br /> R COMMENTS <br /> C TANK MATERI FIBERGLASS, OTHER) <br /> O <br /> N TANK CONDITION (GOOD O S) <br /> S Q <br /> T PIPE MATERIAL (STEEL, FIBERGLASS, O ) Ti FEET <br /> PIPE CONDITION (GOOD, POOR, HOLES) <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE , <br /> T <br /> A <br /> N <br /> K <br /> .S EXCAVATION SIZE -Lq;�X -�6�-�X YDS OF SOIL <br /> A <br /> M DEPTH SOIL TYPE OBSERVATION SAMPLE ,# <br /> P P <br /> L I <br /> I P . <br /> N E <br /> I G <br /> TRENCH DIMENSION X X YDS OF SOIL <br /> DEPTH TO G.W. : FT. SAMPLING METHOD <br /> H <br /> 2 , HOURS SINCE DEWATERING: <br /> 0 <br /> QTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> _F CLOSURE IN PLACE MIXTURE: VOLUME: <br /> EH 23-0043 (REV 2/23/94) PROVIDE SITE MAP <br />